Epidemiology Report

COMMUNITY-BASED ANIMAL HEALTH & PARTICIPATORY EPIDEMIOLOGY UNIT (CAPE) PO Box 30786 Nairobi, Kenya Tel: (254-2) 226447/334550/240591 Fax: (254-2) 253680/226565

PAN AFRICAN PROGRAMME FOR THE CONTROL OF EPIZOOTICS ORGANIZATION OF AFRICAN UNITY (OAU) INTER- AFRICAN BUREAU FOR ANIMAL RESOURCES (IBAR) Proceeding of a workshop held in Addis Ababa, Ethiopia November 15th to 17th, 2001 Edited by Andy Catley and Jeffrey Mariner Contents

Summary i

Abbreviations ii

Acknowledgements ii

Introduction 1

Session 1 Overview of the origins, principles and methods of participatory epidemiology 2 Participatory Epidemiology: Setting the Scene 2 Livestock Keeping and Indigenous Knowledge in the Horn of Africa: Personal reflections on 25 years experience 6

Session 2 Issues affecting the wider use of participatory epidemiology 10 Issue 1 - Qualitative versus quantitative methods 11 Issue 2 - Methodological features of participatory inquiry 13 Issue 3 - Training and learning in participatory epidemiology 16

Session 3 How can participatory epidemiology assist the Pan African Programme for the Control of Epizootics? 18 Participatory Disease Modelling 18 Participatory Epidemiology and Disease Surveillance 18 Experiences with assisting and quantifying disease surveillance information for small ruminants as obtained through the Nomadic Animal Health Auxilliary System (NAHA-System) in Central Rangelands of Somalia 19 Disease surveillance and community-based animal health: experience of the Operation Lifeline Sudan Southern Sector Livestock Programme 22 Participatory Disease Searching 23 Participatory Epidemiology in Veterinary Research and Education 26

Session 4 National PACE Programme Working Groups 27 Tasks for Working Groups 27 Presentations by Working Groups 27 1. Lessons learned during the workshop 27 2. Ways to use Participatory Epidemiology in National PACE Programmes 28 3. Training needs 30

Annex 1 Workshop timetable 32

Annex 2 List of participants 34

Annex 3 Participants’ evaluation of the workshop 37

Participatory Epidemiology: Lessons Learned and Future Directions Summary

The Pan African Programme for the Control of academics and researchers in the Horn of Africa Epizootics (PACE) aims to complete the final Region, and explore how PE might assist national eradication of rinderpest from Africa and improve PACE programmes to achieve their objectives. control of other epizootics diseases such as The workshop comprised a mix of presentations, contagious bovine pleuropneumonia and foot discussion and working groups on key topics, and mouth disease. Experience has shown that and informal networking and exchange of disease control is particularly problematic in experiences and ideas. more remote arid and semi-arid areas inhabited by pastoralist communities. In regions such as Recent developments in the use of PE by the Horn of Africa, logistical and resource veterinarians with pastoralist communities in the constraints are compounded by insecurity and in region included studies of the reliability and some cases, limited government presence. validity of participatory methods, and the development of a disease model for rinderpest Within the PACE Programme, the Community- based on field data derived from PE. These based Animal Health and Participatory experiences were useful for showing how PE can Epidemiology (CAPE) Unit supports the be combined with and complement conventional development of primary-level veterinary services epidemiological approaches. in pastoral areas. The focus is on privatised, community-based delivery systems that are The main outcomes of the workshop were: enabled through appropriate policies and • Improved understanding of the potential roles legislation. CAPE also aims to complement of PE in veterinary epidemiology conventional livestock disease investigation and • Raised awareness of important methodological surveillance methods through the wider issues affecting best practice of PE application of “participatory epidemiology” (PE). • Widespread support for the wider use of PE in Participatory epidemiology has evolved from the national PACE programmes principles and methods of Rapid Rural Appraisal • Interest from veterinary schools for and Participatory Rural Appraisal, and provides incorporating PE into either undergraduate or opportunities to make best use of pastoralists’ postgraduate teaching, and research activities considerable indigenous knowledge on animal • Identification of PE training needs for veterinary health while also encouraging community and livestock workers at central and field levels participation in disease control. During 2002, the CAPE Unit will follow up training However, participatory approaches and methods needs in national PACE programmes and support are not widely used by epidemiology units within teaching and research on PE in veterinary schools State Veterinary Services. This workshop was and research institutes. The contents of an organised by the CAPE Unit to present recent introductory training course on PE were presented developments in PE to senior veterinarians, and discussed during the workshop.

Participatory Epidemiology: Lessons Learned and Future Directions i Abbreviations

ASF African swine fever

CAHW Community-based Animal Health Worker

CAPE Unit Community-based Animal Health and Participatory Epidemiology Unit

CBPP contagious bovine pleuropneumonia

FMD foot and mouth disease

IIED International Institute for Environment and Development

ND Newcastle disease

OAU/IBAR Organization of African Unity/Interafrican Bureau for Animal Resources

PACE Pan African Programme for the Control of Epizootics

PARC Pan African Rinderpest Campaign

PAVE Participatory Approaches to Veterinary Epidemiology Project

PDS Participatory Disease Searching

PE Participatory Epidemiology

PRA Participatory Rural Appraisal

RVF Rift Valley fever

TOT Training of Trainers

Acknowledgements

The workshop Participatory Epidemiology: Lessons Learned and Future Directions was opened by Ato Belay Ejigu, Vice Minister of Agriculture, Federal Democratic Republic of Ethiopia and Woizero Hadera Gebru, Head, Animal Resource and Fisheries Development Department. The workshop was made possible by funding from the Department for International Development (DFID), United Kingdom to the CAPE Unit, PACE Programme, OAU/IBAR.

The CAPE Unit gratefully acknowledges the assistance of Dr.Sileshi Zewde, National Coordinator, PACE Ethiopia and communications staff from PACE Ethiopia. CAPE also appreciates the assistance of Maximilian Baumann (Freie University of Berlin), Berhanu Bedane (PACE Programme), Bryony Jones (VSF Belgium), John McDermott (International Livestock Research Institute), Micheal Thrusfield (University of Edinburgh), Tony Wilsmore (University of Reading) for assisting with facilitation of working group sessions.

ii Participatory Epidemiology: Lessons Learned and Future Directions Introduction

Background Although many veterinarians are now using participatory methods, a number of issues remain Veterinarians in Africa have been using open to discussion and further development. For participatory approaches and methods since the example, while organizations such as IIED late 1980s. Initially, experiences were largely recommend training and field-level practice before derived from community-based animal health using participatory methods, few veterinarians projects where PRA-type methods were used have been trained. Consequently, numerous during project design. Soon after, ‘participatory methods are labeled ‘participatory’ but the disease searching’ evolved in the Pan African principles and best practice of participatory inquiry Rinderpest Campaign (PARC) as a means to trace are often overlooked. Another constraint is the rinderpest foci in remote areas. Over time, pressure for academic researchers to publish in participatory methods have attracted increasing scientific journals, but the qualitative nature of interest from veterinarians and are now used by a participatory research is thought to prevent this. wide range of organizations. A survey of vets And finally, what are the opportunities for conducted with OAU/IBAR assistance in 1999 combining participatory methods with more indicated that participatory methods were useful conventional veterinary investigation and for developing good relationships with epidemiological methods in national PACE communities, understanding local knowledge and programmes? priorities, and were relatively inexpensive and flexible. Workshop objectives

Within OAU/IBAR, two recent developments with The objectives of the workshop were as follows: the use of participatory methods are: 1. Obtain an overview of experiences with the use • The Participatory Approaches to Veterinary of participatory approaches and methods by Epidemiology (PAVE) Project was implemented veterinarians in the Greater Horn of Africa with the International Institute for Environment region. and Development (IIED) from 1998 to 2001, and 2. Identify specific aspects of participatory focused on the reliability and validity of methods in need of further research from a participatory methods. This research compared methodological perspective. data derived from participatory inquiry with that 3. Define opportunities for the use of participatory obtained from conventional veterinary methods by the Pan African Programme for the investigation methods, and also looked at Control of Epizootics. options for quantifying ‘participatory data’. 4. Make recommendations regarding ‘best Three studies were conducted in pastoral areas practice’ use of participatory methods by of southern Sudan, Kenya and Tanzania. veterinarians, including training needs. • In southern Sudan, participatory methods were used to generate data for a disease model for rinderpest. The model proved useful when developing a strategy for rinderpest eradication in southern Sudan.

Participatory Epidemiology: Lessons Learned and Future Directions 1 Session 1 Overview of the origins, principles and methods of participatory epidemiology

Participatory Epidemiology: Setting the Scene

Jeffrey C. Mariner1, Andy Catley1, Darlington Akabwai1, Bryony Jones2 communities affected by the complex emergency in and Tim Leyland1 southern Sudan. 1Community-based Animal Health and Participatory Epidemiology (CAPE) Unit, Pan African Programme for the Control of Epizootics, Organization for African Unity/Interafrican Bureau for Animal As part of the process of designing these Resources, PO Box 30786, 00100 Nairobi, Kenya community-based programmes, participatory rural 2 Vétérinaires sans frontières - Belgium, PO Box 13986, Nairobi, Kenya appraisal techniques were used to conduct needs assessments on animal health issues. The needs Introduction assessments focused on the following areas: • Animal health problems and priorities Simply stated, participatory epidemiology is the • Local veterinary knowledge and concepts application of participatory rural appraisal - Disease vectors, reservoirs, techniques to the collection of epidemiologic epidemiologic understanding information. - Treatment • Appropriate interventions In the current era of globalisation, there is an • Community structure, decision making and increasing demand for animal health information. entry points Internationally, the Sanitary and Phyto-Sanitary Agreement of the Global Agreement on Tariffs and This information was used to formulate projects Trade established science-based methods as the that directly addressed the perceived needs of the basis for livestock and livestock product trade community through an appropriate combination of decision-making. Countries are now required to conventional approaches, local knowledge and provide data to substantiate their national animal community institutions. In the process, all those health status relative to trade. This presents special involved developed a tremendous respect for the problems for developing countries with remote and extent of existing veterinary knowledge on the extensive agriculture systems. Remote and presentation and patterns of disease. This led to the marginalized livestock populations are under- identification of participatory epidemiology (PE) as represented in service delivery and information an area of qualitative inquiry for further systems. As a result, these populations suffer from methodologic development and promotion as an the direct lack of services and pose epidemiologic appropriate technique for the rapid, effective, and risks to the national livestock population as a economic collection of epidemiologic information. whole. The absence of current surveillance information on the animal health status of remote Underlying concepts populations adversely affects export trade. In the late 1980’s Tufts University developed a Participatory approaches are founded on the thermostable vaccine against rinderpest and began philosophy that empowering beneficiaries to implementation of a series of projects to introduce identify and overcome the challenges they are the use of the vaccine at both field and laboratory facing is the surest route to achieving sustainable level as part of the OAU/IBAR Pan African development. The basic requirements for Rinderpest Campaign (PARC). In the course of the practitioners of participatory development are a rinderpest eradication effort, the need for respect for traditional knowledge, willingness to alternative animal health delivery systems for learn, and attitude of open-mindedness. The remote, marginalized communities became experts that apply participatory methods all come apparent. This led to a programme of action with technical educations and skills. The real value research on community-based animal health of these educations is not in providing universal delivery systems that included rinderpest control in models for development but in providing the tools a variety of communities in East and Central Africa. to respond to new information in an innovative and Nearly simultaneously, a major community-based constructive manner. animal health programme was set in motion by Tufts and Unicef to address the basic animal health Participatory rural appraisal (PRA) is a qualitative and rinderpest vaccination needs of the intelligence gathering approach designed to rapidly

2 Participatory Epidemiology: Lessons Learned and Future Directions achieve a best-bet understanding of a situation as a speak for the group. Finally, veterinary basis for an action plan. It is a decision-oriented professional, international experts and individuals information collection and analysis process. A with expert knowledge about the sociology of the multi-disciplinary team of experts usually groups under study are frequently consulted. implements participatory rural appraisals. The PRA method provides a toolkit of techniques and The way qualitative data is assessed and validated activities that facilitate the exchange of is fundamentally different from quantitative data. information. The process is open-ended in that it In the quantitative world, statistics are used to allows the beneficiaries to provide direction to the calculate the probability that randomised information gathering process. This has been information and associations are valid. Validation referred to as discovery and is based on the in the qualitative approach is based on weighing of assumption that the appraisal team cannot and evidence from diverse sources. This may include should not assume that they can anticipate all the information derived from quantitative or issues and information that is important to laboratory-based testing. But PRA can make use of understanding the situation. The process is broader forms of experiential knowledge and participatory since the informants actually benefit information such as oral testimony and from the information collection process. First, the observations from samples of non-random key data collection tools provide an opportunity for informants. community self-realization through better visualization of their life and livelihood situations. The tools of participatory Secondly, the information obtained though PRA is information for action that should result in epidemiology interventions directly benefiting those who provided the data. Participatory epidemiology utilizes the PRA toolkit of methods. These methods may be grouped as The participatory approach makes use of existing secondary sources, direct observation, interview quantitative information and uses qualitative techniques, visualization techniques and methods intelligence to fill the gaps between available data. of ranking and scoring. It is perhaps important to note that quantitative data and the statistical methods used to analyse quantitative data cannot establish casual relations. They merely establish the probability of association between factors. It is in fact other qualitative information that is used to determine casual relationships and essential to the correct interpretation of quantitative data.

In the developing world, the high cost, complexity and lack of flexibility associated with quantitative studies has meant that the availability of quantitative data is very limited. In fact, the very scarcity of quantitative data implies that the data is not representative and has often meant that the information resulting from such studies is misleading.

The method of sampling in PRA studies is based on the principal of key informants rather than randomisation. The study actively seeks individuals who are likely to have specialized knowledge or a uniquely informative perspective on the issues under study. In the case PE, the study team actively seeks out livestock owners and traditional healers who are respected for their ability relative to animal health. Other types of key informants are traditional elders and community leaders who are directly involved in decision- making processes and have some authority to

Participatory Epidemiology: Lessons Learned and Future Directions 3 Secondary sources

Secondary sources refer to existing literature, reports, maps and databases on the communities and issues under study. All good PRA studies begin with an inventory of secondary sources and a review of these sources.

Direct observation

The techniques of direct observation refer to observing the environment and daily activities of livestock owners. One of simplest starting points is to get out and walk through the village or cattle camp and surrounding pasture. Observe the condition of the people, livestock, housing and pasture. Note what plants are present. Try to be present for production activities like milking and note who is carrying-out the tasks and how they are completed.

Semi-structured interviews One of the main tools of participatory epidemiology is the semi-structured interview. In semi-structured interviews, a checklist of subjects to be covered is used as a point of reference rather than a questionnaire. The interview team makes use of open-ended questions to allow participants the opportunity to introduce topics and issues. For example, after introductions, an opening question might be “What are the problems with your livestock?” As the participants introduce topics, probing questions are asked to obtain more detail and check information for internal consistency.

Visualisation techniques Ranking and scoring methods The visualisation techniques include approaches Ranking and scoring refers to a group of such as map, Venn diagram, timeline and seasonal techniques used to prioritise information or calendar construction. Mapping usually involves provide semi-quantitative estimates of the relative clearing an area of sand and sketching with sticks size or impact of categories as perceived by the the relative location of key resource and strategies participants. In ranking, the respondents are asked used by the community. This includes things such to place items in their order of priority. For as grazing areas, cultivation areas, water sources, example, if 5 diseases have been mentioned as salt sources, woodlands, wild foods, wildlife, problems, the interviewer requests that they be habitat of insect vectors of disease, friendly and listed in order of importance. A more systematic unfriendly neighbours, trade routes, seasonal alternative is pair-wise ranking where the movements, and emergency movements. Using respondents are asked to identify which is the this approach, the appraisal team can very quickly more important disease of each possible obtain an overview of the area and the spatial combination of two diseases from the list. distribution of key resources. In epidemiology, the Proportional piling is very flexible technique in spatial relationship between communities, their which respondents are asked to divide 100 objects social relations and movement patterns go a long such as seeds or stones into piles of sizes way towards determining livestock contact patterns representing the relative size or importance of and are key to understanding the epidemiology of different categories. The number of objects in each infectious disease. Timelines and seasonal pile is then counted to give a score. These exercises calendars are very powerful tools for describing can be repeated in subsequent interviews and the the temporal patterns of disease in a location. results analysed statistically.

4 Participatory Epidemiology: Lessons Learned and Future Directions Data validation and analysis Participatory disease searching In PDS, the disease search team is interested in In the process of data collection, the use of information on a specific disease but takes probing questions is an important quality control precautions not to communicate this interest to tool to assess the internal consistency of reports. respondents. Questions are asked about general Once a body of information is obtained from a animal health concerns. If the target disease is series of interviews and data collection exercises, identified as a problem, probing questions can be the information can be assessed through the asked about the target disease in combination process of triangulation. The term triangulation with other subjects. The investigation seeks to simply means comparing information obtained establish the history of the disease in a from multiple informants and multiple methods community and trace reports forwards and to look for patterns. If the information suggests a backwards in time. Often, herders guide the uniform conclusion then the interpretation is disease search team to active cases of disease relatively straightforward. Occasionally, different that can then be confirmed by laboratory groups of key informants may provide conflicting diagnostic methods. An example of a form of information. The study team must then consider timeline, a bar chart illustrating rinderpest how the differing perspectives of the informants reports by from Somali herders, is presented in impact the information obtained. Figure 1. Note that Figure 1 illustrates the principal of triangulation. All the available An important advantage of PE that provides a independent reports form a coherent pattern with high degree of flexibility is iterative analysis. As an inter-epidemic period of about 5 years. the data is gathered, the study team can review the information available and refine the study Another promising application of PE is in the hypotheses. They have the opportunity to include general disease surveillance. Community-based new questions or data collection exercises as a animal health programmes are in place in a result of information discovered during the PRA number of countries and in some countries more process. A further form of analysis is than one thousand community-based animal participatory analysis. Once the study team feels health workers (CAHWs) are active. These they have a reasonable best-bet scenario that programmes are important animal health describes the situation, they can present that information networks. Programme monitors scenario back to the participants. The participants debrief and re-supply CAHWs on a more or less can then add, subtract or clarify information in monthly basis. The CAHWs are aware of major the best-bet scenario. disease outbreaks and are a source of information about trends in endemic disease. Applications of participatory Several appropriate techniques of sample epidemiology collection such as dried blood on filter paper have been developed for both serological and As was mentioned in the introduction, PE was first genetic analysis. At present national disease developed as a project needs assessment tool. It surveillance systems have yet to create a has also found application in animal health project framework to adequately utilize this important monitoring and evaluation. The techniques can be and sensitive source of disease information. used to track changes in disease impact over time as well as to collect the perceptions of Efforts are now underway to combine beneficiaries and other stakeholders on the impact participatory epidemiological approaches with of the project, weaknesses and possible ways to more conventional forms of analytical improve performance. epidemiology. To this end, the Community-based Animal Health and Participatory Epidemiology Perhaps more importantly, PE has important (CAPE) Unit has been supporting the use of PE as applications as an epidemiologic surveillance tool in a method of collecting expert opinion for use in its own right. Participatory epidemiology has been infectious disease modelling. Also, studies have adapted as a very successful method of targeted been completed by the PAVE Project to validate surveillance for rinderpest. In fact, a few low cost existing veterinary knowledge as a form of and relative sort-term PE studies have dramatically epidemiologic data. The results of this work altered the conventional wisdom regarding the suggest that combinations of both participatory mechanisms of endemicity and spatial distribution and analytic techniques yield an extremely of rinderpest in East Africa. This approach has been powerful approach to the study of epidemiology. termed participatory disease searching (PDS).

Participatory Epidemiology: Lessons Learned and Future Directions 5 Livestock keeping and indigenous knowledge in the Horn of Africa: Personal reflections on 25 years experience

Darlington Akabwai The unique characteristics of the pastoralists areas Community-based Animal Health and Participatory Epidemiology (CAPE) Unit, Pan African Programme for the 1. Harsh climate and rugged topography. Control of Epizootics, Organization for African Unity/ 2. Remote, largely inaccessible by road and Interafrican Bureau for Animal Resources, PO Box 30786, 00100 Nairobi, Kenya distant from public-and private-sector centralized services. This paper focuses on one aspect of 3. Movement in search of pasture and water is pastoralists - the ethnoveterinary knowledge key to survival (satellite camps or kraals at (EVK) which has enabled them to scrape a Awi ; home site - Ere) living from a climatically hostile ecosystem for 4. The pastoralists are often branded “unwilling ages. The vehicle of survival has mainly been to change” but they cannot afford the luxury livestock keeping and the accumulated of experiments offered by the outsiders. quantum of traditional knowledge is based on 5. Maintain traditional structures, - pillars of this livelihood. The paper goes on to highlights decision-making. specific examples of EVK that pastoralists have 6. They have complex decision making acquired from time immemorial and processes recommends that veterinary epidemiologists 7. Suffer from colonial and post colonial open their attitudes in order to tap this EVK isolation - marginalization from pastoralists. This is particularly important during the last stages of rinderpest disease 8. Still hanging on dependency syndrome of control and that is at the surveillance and handouts and this has slowed down disease search stages. privatization efforts. 9. Insecurity due to civil conflict and the deadly Introduction cross-border raids.

The Horn of Africa is home to around 20 million pastoralists. In general, pastoralists’ areas are The weakness of veterinary places with unique characteristics that have epidemiology in pastoralists areas produced unique constraints among its inhabitants (see Box opposite). It is these As noted above, many veterinary epidemiologists constraints that have hardened the inhabitants are not aware that pastoralists are well equipped of these areas to withstand the rigors of harsh with very valuable EVK and are unwilling to learn environmental conditions. When outsiders from these local experts. There are many reasons come to the Horn they are bound to complain for this lack of awareness, but the most obvious is of the harsh climate and wonder how the that they have not been formally trained in their inhabitants can live with their livestock quite institutions of learning about the pastoralists and comfortably. In contrast, the real pastoralist their unique EVK. Worse still, they have not had finds everything normal because he or she has any opportunity to learn it themselves in the field known no other environment since childhood. since most of them are not willing as pointed They have accumulated vast traditional above. The question is why have they not taken the knowledge and experience on the tactics of trouble to tap this knowledge among pastoralists survival in these environments. That is why and yet these livestock owners are so vital in the pastoralists are experts on issues of livestock epidemiology and the eradication of livestock keeping in their environments. To them, diseases in the Horn of Africa? livestock keeping is the most reliable livelihood • One obvious reason is that most veterinary as it offers them the most successful coping professionals come from outside the strategies for survival. It is however pastoralists’ areas and they are therefore not unfortunate that most outsiders coming to the keen to come closer to the pastoralists. They pastoral areas are not aware of the existence of generally have negative attitudes towards these such EVK among pastoralists. Some veterinary people. epidemiologists belong to this category. • The other reason is that veterinary epidemiologists are trained to work with

6 Participatory Epidemiology: Lessons Learned and Future Directions sedentary herds using conventional approaches. addition, stars help them to foretell the severity of They cannot accommodate the dynamics of an impending drought! pastoralists’ areas and lack the inherent flexibility required to work in such areas. Experts in obstetrics and animal reproduction

• The veterinarians cannot therefore reach the The most valued item in livestock keeping among traditional knowledge system (EVK) that is pastoralists is milk. Pastoralists begin talking about embedded in the cultural matrix of these milk the very day a cow is serviced by a bull. They people. know the pregnancy periods of all their domestic • These factors have contributed to the poor animals and they take care to monitor the days of performance of veterinary service delivery in pregnancy for each cow or camel. For example, a these unique areas, thus exacerbating the Turkana pastoralist knows that the gestation period marginalization of the pastoralists. for a camel is thirteen lunar months. He knows this from years of patient observation. And to make These factors will continue to impact negatively on sure he does not forget when to start getting milk, the surveillance stage of disease control programs. each month that passes is recorded with a line drawn on the head stool until the thirteen lunar Ethnoveterinary knowledge among months have passed and the pregnant camel calves down. pastoralists: some examples Correcting cases of infertility Wherever they exist in Africa, pastoralists have tried to devise ways of living in harmony with their harsh The reproductive capacity of any given animal is environment. Broadly speaking these ways are many observed with keenness. For instance the and diverse, and continue to be changed with time anoestrus cows are taken to salty pastures for and with new challenges. A few examples of these grazing. To a Turkana pastoralist, the salty grass will traditional knowledge systems are given below. replace the missing salt and minerals which could include the phosphates. Pastoralists report positive Expert knowledge on range ecology responses as most of the cows returning from akicuar (meaning to quench the thirst for salt) Pastoralists have learnt how to manage their fragile actually come back pregnant. Some pastoralists ecosystem. Despite the fact that they have been also perform a surgery on the clitoris of heifers accused of causing widespread overgrazing and that have failed to become pregnant. When the tip mismanagement of their production system, they of the clitoris is cut off slightly, the heifer is are pleading innocence until proven guilty. This is stimulated and eventually gets pregnant when because they are very knowledgeable about their served. It is not known as yet what happens but it land forms, soil and pasture types, and they know is popular management of heifer infertility among the capacities of their wells and most of the most pastoralists. watering points. Knowledge about salty pastures, red or black soils found in rolling plains or at the Assisting calvings shoulders of hills are examples of their ability to All pastoralist know in one way or the other to help closely observe their ecosystems. In addition, their cows to calve down. But at the same time pastoralists have designed grazing patterns that there are people whom each community recognizes take into account the production capacity and the as the experts in handling the most difficult dynamics of their ecosystem for any given season. obstetrical cases. These are often consulted using a traditional fee. One of the elements of a grazing pattern is movement. To a pastoralist and contrary to popular Ability to communicate clearly belief, nomadism is not haphazard but is a calculated response to cope up with hostile Most pastoralists are good orators but in any tree- changes in one part of the grazing areas. It is a of-men (Ekitoengikiliok in Turkana; Kokwo in Pokot) survival coping strategy that has developed with there are always expert communicators that the time. In the final analysis they are capable of community has recognized as talented orators. managing their production system without These are the people who will be given the damaging it. In fact, they accuse outsiders as the responsibility of repeating the discussion that goes main cause of environmental degradation in on in the tree-of-men so that everybody will get the pastoral areas. Pastoralists have devised even message clear and loud. This is a traditional skill seasonal calendars for specific areas and use the which is unique to pastoralist communities and stars to tell the beginning and end of a season. In should be taken seriously by outsiders attempting to work with these communities.

Participatory Epidemiology: Lessons Learned and Future Directions 7 Knowledge about pastoralist home economics lacrimation and nasal discharges, involving very many cattle in herd and easily spreads to other It is the pastoral woman who is the authority when neighboring herds in an outbreak fashion. It is the it comes to the matters of food production in a widespread lacrimation signaling a catastrophic pastoralists household. She has acquired the skills episode or plague that stimulated the coinage of of an ant that gathers and stores during times of the name. The plague often involved not only cattle plenty to be used when things go bad. For instance but even buffalo herds. In this case, when herders most pastoralist women are skillful in drying milk notice emaciated buffaloes they move their cattle during the wet season when there is surplus away to avoid the disease. Loleeo is borrowed from production. That powdered milk will be fed on their neighbours, the Karamojong, where that word mainly children when the drought becomes severe. means ‘malicious’. The Turkana use the word to Similarly some milk is cooked into ghee for use describe a unique type of pipe-stem diarrhoea later. The desert fruits are also dried for the same which is watery and greenish brown. purpose. The Somali women are particularly well known for preserving camel meat into nyirinyir The Fulani of Cameroon call rinderpest pettu (minced paste). It is a delicacy for Somali men and which they like to a strong wind that destroys a lot it adds love for his wife. of fruits when it passes through a laden mango or apple tree. The picture paints rinderpest as being Livestock disease perceptions and etymology capable of blowing through cattle herds, leaving among pastoralists them dead. The Afar of Ethiopia, call rinderpest degahabe which means ‘empty kraal’ - it comes A few examples are given to illustrate the livestock from the expression geso foyas habe which means disease perception and etymology as given by ‘the kraal of cattle is empty’. various pastoral groups. The Dinker Rek and Dinker Boor of southern Sudan Blackquarter call rinderpest awet or nyan tek. The word awet comes from wet piny, which in Dinka Rek means to This is a livestock disease that is recognized and scatter down like a hen that scatters the sorghum accurately described by most pastoralists and grain when it is fed in a container. The older Dinka agro-pastoralists. The Turkana pastoralists, call it compared this observation to a disease, which lokichuma which literally means ‘piercing pain’ scatters down cattle. The Dinka Bor called it nyan (from akicum meaning ‘to pierce’). The tek meaning ‘one calf remains’. This indicates the description was borrowed from human feelings manner in which rinderpest kills all the cattle, as the Turkana pastoralist watched, with imagined leaving only one or a few animals to become pain, the limping of the sick cow. The Fulani of immune to the disease. Cameroon call this disease labba meaning the ‘Devil’s spear’. The Fulani believe that the lesion The Latuko of southern Sudan give to rinderpest which causes the sick animal to limp came as a the name lopirit. This is derived from the word result of the animal being pierced by the Devil’s pirit, referring to the speed at which a fluid is spear which pierces the heavy muscles without emitted. When the expression is used to describe physically cutting the hide. Similarly the Afar of a disease in cattle, it refers to projectile emission Ethiopia name this disease harraymude where of watery faeces. harra means ‘forequarter’ and mude means ‘to All the above people are aware of the presence of pierce or to spear’. modern vaccines and admit that they have no treatment of their own. However, they do have Rinderpest sophisticated quarantine procedures, which they Rinderpest is a livestock disease that can cause put into effect during outbreaks. very high mortality. The disease is endemic in specific inaccessible pastoralist areas in the sub- Trypanosomiasis Saharan Africa. The names given to rinderpest by The disease is common in many pastoral and agro- the various cattle keeping communities tell very pastrol areas. The main vector being the tsetse fly vivid stories that can be very effective tools for though biting flies contribute by mechanical awareness creation. transmission. This protozoan disease affects all The Turkana give the traditional name for domestic animal but the examples given here are rinderpest as lokiyo or loleeo. The two names were mainly from cattle. derived by the Turkana pastoralists as follows. The Turkana of Kenya and the Toposa of southern Ngakiyo in English means ‘tears’ and lokiyo Sudan call trypanosomiasis in cattle lokipi. The denotes a livestock disease manifested by copious name comes from ngakipi which means ‘water’. This

8 Participatory Epidemiology: Lessons Learned and Future Directions word describes the disease of cattle which is Conclusions characterized by widespread oedema in the body of As indicated above, pastoralists have accumulated the affected animal, during the final stage of a a vast amount of traditional knowledge that has wasting condition. The carcass literally quenches enabled them to utilize livestock keeping as a viable fire and releases a lot of smoke when roasted. livelihood. It is now up to us to open ourselves to The Didinga and Latuko of southern Sudan call tap this EVK in order to enrich modern trypanosomiasis lobi. The word lobi in the two epidemiology. This will entail a complete change of tribal groups describes gradual loss of body attitudes on our side as professionals and a move condition of the affected cow. The disease is closer to the grassroots where the custodians of that spread by the tsetse fly (called lolir in LatukoI and knowledge reside. It means we have to reseek the ikirongit in Didinga). people, accept nomadism as a coping strategy for survival rather than viewed it as unnecessary The Nuer of southern Sudan call trypanosomiasis loitering by those people, that we become flexible liey/guaw and they derive these two names from liy and broad minded instead of being the rigid meaning stealing slowly, like something is secretly veterinarians that we have been accused of, and that removing something from inside the animal which we should be prepared to learn the livestock disease becomes thin. Guaw is a cattle disease perceptions of the livestock owners and the way characterized by gradual loss of condition, periodic disease names are derived from the socio-cultural fever, sunken eyes, lacrimation and photophobia. backgrounds. This is particularly important at the Frequently these animals seek shade and have hair last stages of rinderpest disease control and that is loss in from their tails. at the surveillance and disease search stages. In nearly all cases the pastoralists have been Pastoralists ability to identify and describe exposed to modern trypanocidal drugs, such as accurately the livestock diseases will be a real asset. ethidium bromide. They associate the effectiveness This is because this people will hardly miss a case! of these modern drugs with their local terms for trypanosomiasis , thus indicating they are correct Bibliography in their diagnosis. There is some evidence that the Catley, A., Leyland, T., 2001. Community participation and the local names which describe wasting diseases (e.g. delivery of veterinary services in Africa. Preventive in southern Sudan) may in fact be a combination of Veterinary Medicine 49, 95-113. several diseases such as combined infection of Grandin, B., 1986. Wealth ranking in small holder communities: a field manual. ITDG Publications, London. liver fluke with trypanosomiasis. Ohta, I., 1984. Symptoms are classified into diagnostic categories: Turkana’s view of livestock disease. African Disease diagnosis and use of traditional remedies Monographs supplementary issues 3, 71-93. Katabarwa, N.M., Richards, Jr. F.O., Ndyomugenyi R., 2000. In These few examples of livestock disease rural Ugandan communities the traditional kinship/clan perceptions by the pastoralists show that system is vital to the success and sustainment of the African Program for Onchocerciasis Control. Annals of Tropical Medicine pastoralists are very good in diagnosing livestock and Parasitology, 94(5), 485-495. disease entities in their traditional way. In fact, Mariner, J.C., 2001. Report of the Consultancy to Assist in the when discussing the Turkana classification of Development of a Rinderpest Eradication Strategy in the livestock diseases Ohta (1984) stated that “They West and East Nile Ecosystems. Community-based Animal Health and Epidemiology (CAPE) Unit, Pan African Programme for classify the conspicuous uncommonness visible on the Control of Epizootics (PACE), Nairobi. the animal”. In other words the Turkana identify Oba Gufu, 1985. Perception of Environment among Kenyan what they believe are defining symptoms and Pastoralists: Implications for Development. Nomadic Peoples, 19, 33-57 name the disease accordingly. It is after diagnosing Prior, J., 1994. Pastoral Development Planning. Oxfam Development that they indicate traditional remedies for these Guidelines No. 9, Oxfam Publications, Oxford. disease entities. All pastoral groups in sub-saharan Sollod, A.E., Stem, C., 1991. Appropriate animal health information Africa express this ability with pride. systems for nomadic and trans-humant livestock populations in Africa. Rev. sci. tech. Off. Int. Epiz., 10(1), 89-101. Stem, C., 1996. Ethnoveterinary Research in a Livestock In both East and West Africa traditional medications Development Context. In: Ethnoveterinary Research and are well known and discussed freely. For instance Development. (pp.193-206). McCorkle, Constance M. and Evelyn Mathias-Mundy eds. Intermediate Technology Publications. 1996. the Fulani known as the WodaBee in Niger and the Stem, C., Sollod, E.A., 1994. Rapid reconnaissance in animal Taureg in Niger are skillful in vaccinating their health planning for pastoral production systems. Kenya cattle against contagious bovine pleural Veterinarian. 18 (2) 51-54. August 1994. Proceedings of the pneumonia (CBPP) by placing a piece of infected 7th International Symposium on Veterinary Epidemiology and Economics, Nairobi, August 1994. lung from a cow that has died of CBPP into a fold UNICEF, 1996, A study on the Ethno-Veterinary Knowledge of of slit skin on the side of the nose of cattle to be the Dinka and Nuer in Southern Sudan. Operation Lifeline vaccinated (Stem, 1996). Sudan - Livestock Programme. UNICEF-OLS, Nairobi.

Participatory Epidemiology: Lessons Learned and Future Directions 9 Session 2 Issues affecting the wider use of participatory epidemiology

Andy Catley • Veterinary uses of participatory methods Community-based Animal Health and Participatory • Perceptions on strengths and weaknesses of Epidemiology (CAPE) Unit, Pan African Programme for the Control of Epizootics, Organization for African Unity/ participatory methods Interafrican Bureau for Animal Resources, PO Box 30786, 00100 Nairobi, Kenya The questionnaire was administered to Directors of Veterinary Services, PARC National Introduction Coordinators, Deans of African veterinary schools, veterinarians working with major donors, NGOs, This session was introduced by reference to a research centers and international agencies. The survey of veterinary uses of participatory appraisal response rate was 28.6% (50 responses from 175 in Africa conducted in 1998-19991. questionnaires administered). Response rates The survey targeted veterinarians and used a varied from 15.6% from government-employed questionnaire to assess: veterinarians to 47.6% from veterinarians employed • Understanding of participatory approaches and by NGOs. Some of the results were presented as methods summarized below.

Table 2.1 The main advantages of participatory appraisal as perceived by veterinarians working in Africa

Advantages Number of times advantages cited

Aimed at community priorities and context 23 Inclusive; includes all social groups in the community 12 Improves relationships, trust and rapport between outsiders and communities 11 Rapid 10 Results reached and decisions made by consensus 8 Inexpensive because uses local resources 7 Encourages community-level problem solving 5 Promotes indigenous technical knowledge 5 Increase local, community ownership of projects 5 Enables outsiders to learn about communities 5

Table 2.2 The main disadvantages of participatory appraisal as perceived by veterinarians working in Africa

Disadvantages Number of times disadvantages cited

Time consuming 17 Generates qualitative data 11 Requires high resources 9 Language/translation problems at field 8 Requires much patience on the part of the facilitators 5 Manipulation by project to achieve it’s own aims 5 Seen as a panacea data collection method by donors 4 Requires very skilled facilitators 3 Unpopular with central decision-makers in government 3 Improper use of tools 3

1 Catley, A. (1999). The use of participatory appraisal by veterinarians in Africa. Office International des Epizooties Scientific and Technical Review, 19 (3), 702-714.

10 Participatory Epidemiology: Lessons Learned and Future Directions Table 2.3 The main constraints to the use of participatory appraisal by veterinarians working in Africa

Constraints to usage Number of times constraints cited

Lack of financial resources 13 Lack of suitable training courses 13 Lack of time to attend training 12 Poor acceptance and negative attitudes among veterinarians 6 Lack of relevant literature and training manuals 4 Logistical problems 3 Lack of forum to share experiences 3 No facilities to cross-check data using conventional means 2 Poor public awareness of the approach 2 External constraints e.g. conflict, food shortages 2

It was suggested that a number of issues arising for the survey should form the basis for further discussion by workshop participants. These issues were: Issue 1 The use of qualitative versus quantitative methods Issue 2 Methodological issues Issue 3 Training and learning issues

Issue 1 Qualitative versus quantitative methods To discuss this issue, participants were divided into five working groups and each group was asked to identify the strengths and weakness of qualitative, quantitative and combined qualitative-quantitative methods. The results from the working groups are summarized in Table 2.4 opposite.The facilitator expanded on some of these points as follows:

Quantitative methods In the ‘hard science’ establishment, quantitative methods are strongly associated with ‘good • Quantitative methods assume that the world science’. can be described using facts that are discovered using objective research. The approach focuses on instrumental knowledge Qualitative methods • Objective, quantitative research is based on • In comparison with quantitative research, methods that separate the object of inquiry qualitative research often aims to understand from investigating subject relationships in a specific, often localised • This requires a complex world to be context. compartmentalised into manageable units, • Therefore, qualitative research does not seek to which can be controlled, manipulated and extrapolate research findings to a larger studied. population. • Judged according to four main criteria viz. • Often aims to understand critical or interactive internal validity; external validity; objectivity knowledge. and reliability • Uses inductive research methods; sources of • Issues of validity and reliability are usually error cannot always be predicted at the onset. addressed at the design stage of the research, • Validity based on triangulation of data - using techniques such as random sampling, comparison of results arising from different selection of appropriate sample sizes and use of methods and informants. controls. This approach enables the use of • Validity is highly dependent on the skill of the probability statements to describe associations researcher and their capacity to cross-check in large populations. information as it emerges.

Participatory Epidemiology: Lessons Learned and Future Directions 11 Table 2.4 Working Group perceptions of quantitative and qualitative methods

Strengths Weaknesses

Quantitative Reliable and repeatable Expensive and boring Statistical tools well-developed Long time frames required Proven, well-tested methods Difficult to sustain Technical qualified people available Requires a lot manpower Widely accepted by decision makers, Highly trained people policy makers and academics Logistically difficult Objective Techniques can be used inappropriately Auditable Less flexible Allows direct comparison Not easily understandable Representative Feedback to communities difficult Easy to interpret and extrapolate Limited attention to indigenous knowledge More in-depth statistical analysis Less community involvement/ownership Defined methods available to test Interpretation difficult without background specific questions qualitative information More accepted as “proof”

Qualitative More participatory Subjective More sustainable and interesting Not accepted as a strong method e.g. by Multidisciplinary and multidimensional decision makers More information than numbers alone Requires trained people Quick Transaction concerns Better for feeding back to people; Difficult to audit supports quick implementation of Difficult to quantify information findings Need of local knowledge and language Indigenous knowledge Analyses tools not well developed Individual observations from local Standardization often poor knowledge has significant Lack of best practice rules Demands few resources Not everyone can do PRA (even when trained) Community and interviewer gains from May lack repeatability and comparability process Lack of awareness of participatory methods Discover unexpected, useful information among policy makers other stakeholders Takes care of farmer circumstance Establishing ownership Broad issue Understand remote communities More sociality acceptable

Combination More reliable Expensive More sustainable Required long-term commitment and Less manpower resources Broader participation More realistic - most of time this in fact happening Can help to rule out weaknesses of qualitative and quantitative approaches More acceptable by donor countries More accepted by community and people improved “Best of both approaches” Allows participations of different types of expertise More verification possible

12 Participatory Epidemiology: Lessons Learned and Future Directions Issue 2 Methodological features of participatory inquiry

This session focused on three aspects of is then combined and cross-checked to build a participatory epidemiology which are commonly picture of the issues under investigation. misunderstood. This process is similar to clinical veterinary Confusion with questionnaires inquiry. When visiting a farm, a veterinarian observes the conditions on the farm and the Some workers consider the methods of animals, and cross-checks these observations participatory epidemiology to be “just like a with information provided by the farmer. questionnaire”. However, an important influence Similarly, when examining sick livestock the on the development of participatory methods was clinician is constantly comparing what is dissatisfaction with questionnaire surveys among detected visually (or with a thermometer or development workers. Questionnaires were often stethoscope) with the description provided by the difficult to design and administer, and were based livestock keeper. As the investigation proceeds, on the priorities and perceptions of researchers, samples might be taken for laboratory tests. rather than local people. Although best-practice Therefore, a combination of direct observation, guidelines for using questionnaires were owner interview, clinical examination and available, they were rarely followed. For example, laboratory tests help the veterinarian to reach a pretesting of questionnaires was often overlooked diagnosis - this is an example of triangulation. and the problem of non-sampling errors was In participatory epidemiology, triangulation is usually ignored. Possible confusion over use of important because it helps to ensure the validity language, particularly translation of technical and reliability of findings. The process requires terms, was another issue. practitioners to be constantly aware of why a particular method is being used and how results In remote areas, pretesting of questionnaires can will be compared with results derived from other be logistically difficult and time consuming. methods. Also, when compiling reports it is Similarly, after the administration of necessary to describe how information from questionnaires and collection of data, the analysis different sources and methods was combined to is often conducted back in the laboratory or office. give “the diagnosis” and make This means that if discrepancies or unusual recommendations. information arises during the analysis, it is difficult to verify the original data.

In part, participatory inquiry attempts to overcome Figure 1 some of the problems of questionnaires. Typically, The methods of participatory epidemiology local priorities are discussed using local language and disease terms. The overall approach is not to ask standard questions to a set number of people, but to explore and analyse issues and follow-up interesting leads. In other words, the approach is open-ended and flexible.

Triangulation

An important feature of participatory epidemiology is the use of different methods with different informants. Some of the most commonly used methods are summarised in Figure 1 and comprise three main groups - interviewing, visualization and ranking (and scoring). These three groups of methods are complemented by reference to secondary sources (reports, literature) and direct observation in the field. Information derived from all these sources

Participatory Epidemiology: Lessons Learned and Future Directions 13 “Participatory methods are Participatory methods such as proportional piling can be easily standardized to understand local qualitative, so we can’t publish perceptions of disease incidence. the work” Example

While the qualitative nature of participatory Use of proportional piling to estimate incidence of epidemiology is clearly a concern for many cattle diseases in Tana River District, Kenya3 veterinarians, it seems to be a particular problem for academics and researchers. The perception seems to As part of participatory research project on bovine be that unless research involves the collection of trypanosomiasis, a proportional piling method was numerical data and presents some statistical developed to understand local perceptions of the summary or analysis, findings cannot be published in relative incidence of livestock diseases in different journals. When researchers are judged within a age groups of cattle during the preceding 12-month “publish or perish” culture, they favour conventional period. Interviews with Orma informants indicated methods which are known and accepted by their that their cattle were categorised by age group as peers and reviewers for scientific journals. jabie (calves to weaning age; 0-2 years of age), waela (weaner group, 2-3 years old), goromsa When considering this issue, two points were made: (young adult stock, including heifers and young bulls; age group 3 to 4 years) and hawicha (adult • It is possible to describe many subjective stock, particularly the milking cows kept around the opinions using numbers. For example, preference permanent villages; > 4 years of age). ranking requires an informant to assign numerical ranks to items or issues to demonstrate their Using a pile of 100 stones to depict each age preferences. In veterinary medicine, we group, the stones were divided by informants into commonly use body condition scores to ‘sick cattle during the last year’ and ‘healthy cattle summarise a subjective assessment of an during the last year’. The pile of stones animal’s condition. Similarly, we can assign ranks representing sick cattle was then sub-divided by or scores to lesions or clinical observations. informants to show the relative numbers of cattle • By standardizing a ranking or scoring method, suffering from gandi/trypanosomiasis, hoyale/foot and then repeating the method, we produce and mouth disease, buku/acute haemorrhagic numerical data that can be summarized using trypanosomiasis, somba/ CBPP, madobesa/ common and simple statistical methods. rinderpest and ‘other diseases’. The method was repeated with 50 Orma pastoralists. An example of In participatory epidemiology, ranking and scoring the kind of information arising from this method is methods produce numerical data at an early stage presented in Figures 2 and 3 overleaf. in the method. Typically, within a particular survey these methods have been used as ‘one-off’ Important features of this proportional piling methods. For example, the results below show how method were: one group of farmers ranked livestock diseases in • Relationships between local disease names and terms of morbidity and mortality2. veterinary terminology had been previously determined using other participatory methods, Scoring of livestock diseases in Abela Sipa, such as matrix scoring of disease signs North Omo, Ethiopia supported by comparisons of local disease descriptions with standard veterinary textbook Disease Mortality Morbility descriptions. trypanosomiasis *****(5) *********(9) anthrax ********(8) ****(4) • This method was thought to be superior to questionnaires, because, blackleg ********(8) ****(4) - local terminology was used for the diseases ticks and tick-borne and cattle age groups; disease **(2) *******(7) - the comparison of different diseases internal parasites - (0) ********(8) reduced exaggeration; - the piling process was partly visual i.e. Note: A group of 12 male farmers were asked to score the five most important diseases in Abela Sipa peasant association out of informants could see representations of sick 10, in terms of mortality and morbility.

2 IIED and Farm Africa (1991). Farmer Participatory Research in North 3 Catley, A., Irungu, P., Simiyu, K., Dadye, J. Mwakio, W., Kiragu J. and Omo, Ethiopia: Report of a Training Course in Rapid Rural Appraisal. Nyamwaro, S.O. (2002). Participatory investigations of bovine International Institute for Environment and Development, London. trypanosomiasis in Tana River District, Kenya. Medical and Veterinary Entomology, 16, 1-12.

14 Participatory Epidemiology: Lessons Learned and Future Directions cattle (whereas a questionnaire involves Summary only verbal communication); - the method is flexible and informants can In summary, participatory epidemiology involves: move stones between piles until they’re • an approach and toolkit of methods that vary comfortable with their responses; considerably from questionnaires; - responses can be checked and probed using • the use of interviewing, diagramming and open questions. scoring tools supported by reference to secondary literature and direct observation, However, there are also potential pitfalls when leading to immediate field-level triangulation of using this type of method: data; • if required, some standardization and repetition • it requires very careful training of researchers of methods to produce numerical data. and epidemiologists; • there is a strong tendency to focus on Examples of research publications based on “collecting the numbers” rather than following participatory methods were distributed to up results with probing questions; workshops participants. • there is a strong tendency for researchers to record only the numbers, rather than also write notes on the following discussion.

Figure 2 Estimated annual incidence of bovine trypanosomiasis (gandi) by age group

Age groups: Jabie, 0-2 years Waela, 2-3 years Goromsa, 3-4 years Hawicha, > 4 years

Figure 3 Estimated mean incidence of cattle diseases relative to healthy cattle, all age groups, 1999 - 2000

Participatory Epidemiology: Lessons Learned and Future Directions 15 Issue 3 Training and learning in participatory epidemiology

Training Courses Session 5: Methods - interviewing methods Principles of informal interviewing The rapid growth of RRA and PRA in development Use of open and probing questions work has been accompanied by the emergence of Use of checklists - written and mental numerous training courses. These courses vary Examples from veterinary epidemiology considerably in their content, training Practical sessions methodology, duration and trainer experience. During the workshop, a training course in Session 6: Visualisation methods - participatory participatory epidemiology for veterinarians was mapping proposed based on the courses run by the Priniciples of mapping International Institute for Environment and Types of maps (social, natural resource, movement etc.) Development and the Institute of Development Examples of maps used in epidemiology Studies in the late 1980s and 1990s. These courses Practical sessions included initial classroom-based sessions followed by field practice. The length of the courses was Session 7: Visualisation methods - Seasonal around 10 days. Calendars Therefore, the proposed training course in Principles and methodologies participatory epidemiology comprised the Examples from epidemiology following sessions: Practical sessions

Outline of an Introductory Training Course in Session 8: Ranking and scoring methods Participatory Epidemiology Principles of ranking and scoring Types of ranking and scoring Session 1: Origins of participatory approaches and Examples from epidemiology methods Practical sessions Farming Systems Research Applied Anthropology Session 9: Summarising and analysing data Adult Education Movement How to handle ranks and scores Agroecosystem Analysis Statistical tests for non parametric data Rapid Rural Appraisal Assessing agreement between informants Multidimensional scaling, GPA, correspondence Session 2: Concepts of community participation in analysis and other methods development Historical background to community participation Field practice: Five days in the field Meanings of community participation This is crucial! Examples of applications, uses and abuses Provides opportunity to practice methods and address any misunderstandings Session 3: “Rural Development Tourism” Summarise and analyse data - in the field Spatial bias Feedback and cross-check findings Temporal bias Evaluation of methods Project bias Write report Diplomatic bias Person bias Professional bias Who To Train?

It is often said that ‘not everyone can do PRA’. In Session 4: Key features of participatory fact, a growing body of experience in participatory epidemiology approaches and methods in various technical Attitudes and behaviour of practitioners sectors shows how the attitudes and behaviour of Mixed methods- participatory and conventional practitioners is probably more important than their Secondary data knowledge about specific methods. This experience Managing groups indicates that certain types of people feel more Key informants comfortable with PRA than others and are more Triangulation successful at applying the approach. Optimal ignorance

16 Participatory Epidemiology: Lessons Learned and Future Directions In order to prompt discussion on the characteristics 4. How do you prefer to organise your life? of a ‘good participatory epidemiologist’, Jeffrey - In a structured way, making decisions and Mariner introduced participants to the Briggs knowing where you stand? Myers Personality Type. This system helps to - In a flexible way, discovering life as you go characterise people by personality type and is used along? by various organizations to assign tasks to staff Judgement Perception with particular attributes. Close Open Decide Explore At its most basic level, the Briggs Myers uses the Structure Meander following characteristics: Organise Inquire Firmness Flexibility Extrovert (E) Introvert (I) Control Spontaneity Sensing (S) intuition (N) Thinking (T) Feeling (F) Although there wasn’t enough time during the Judging (J) Perceiving (P) workshop for a thorough discussion on this personality test, the key point was that different These characteristics are explored through a series people have different characteristics and of questions: behaviours. For epidemiologists, some people are 1. Where do you direct your energy? instinctively more at ease when dealing with - To the outer world of activity, and spoken words? objective data and ‘black and white’ situations - To the inner world of thought and emotions? whereas other people seek to understand grey areas and can cope easily with uncertainty. Characterisitics associated with extrovert verses Similarly, some researchers prefer the structure of introvert people are as follows: a pre-ordered learning process but others prefer Extroversion Introversion open-ended inquiry and like to respond to new Social Private information as it arises. Expressive Quiet Many Few Recognition of these kinds of attributes together Broad Deep with communication skills can assist senior Interaction Concentration managers to identify staff who are most likely to Outward Inward benefit from training in PE and apply the Action before thought Thought before action approaches and methods effectively in the field. Such people are usually natural and relaxed 2. How do you process information? communicators, observant of local customs and - In the form of known facts and familiar terms? norms, and respectful of other people’s views. - In the form of possibilities or new potential?

Sensing Intuition Facts Patterns Experience Novelty Present Future Practicality Aspiration Enjoyment Development Realism Idealism Using Changing

3. How do you make decisions? - On the basis of logic and objective considerations? - On the basis of personal values?

Thinking Feeling Analysing Sympathising Objective Subjective Logical Personal Criticism Appreciation Onlooker Participant Decides on principle Decides using values Long term view Immediate view

Participatory Epidemiology: Lessons Learned and Future Directions 17 Session 3 How can participatory epidemiology assist PACE?

Participatory Disease Participatory epidemiologic tools were utilized to estimate population demographics, rinderpest Modelling mortality rates, population contact structure and inter-epidemic periods. Published laboratory Jeffrey C. Mariner1, John McDermott2, Andy Catley1 and Peter inoculation data was used to estimate latency and 3 Roeder infectious period. The basic reproductive number 1Community-based Animal Health and Participatory Epidemiology (CAPE) Unit, Pan African Programme for the was derived from serologic data obtained during Control of Epizootics, Organization for African Unity/ periods of endemic stability. The estimates of Interafrican Bureau for Animal Resources, PO Box 30786, basic reproductive number and infectious period 00100 Nairobi, Kenya 2International Livestock Research Institute, PO Box 30709, were in turn used to estimate effective contact Nairobi, Kenya rates. The model was validated by comparing the 3Emergency Prevention System for Tranboundary Animal and predicted epidemic curves with historic Plants Pests and Diseases (EMPRES), Animal Health Service, information provided by farmers on the actual Animal Production and Health Division, Food and Agriculture Organization, Viale delle Terme di Caracalla, 00100 Rome. Italy. temporal patterns of outbreaks in two different endemic scenarios. Infectious disease modelling relies upon quantitative data and expert opinion to make The model is a simple, open population SEIR state parameter estimates. In conventional disease transition model that incorporates stochastic modelling experts include epidemiologists and elements when transmission levels are low. microbiologists. This paper describes a state- The structure of the model is presented in Figure transition model of rinderpest transmission 1. The model incorporates vaccination as either a dynamics in East Africa. The model differs from continuous or a seasonally pulsed process. previous rinderpest models and disease models in general in that the knowledge of the owners of the Rinderpest is southern Sudan is caused by livestock populations being modelled is utilized as moderately virulent rinderpest virus from African expert opinion to derive parameter estimates and lineage 1. In Somali, a mild form of rinderpest due validate the model. to Africa lineage 2 is believed to be present. The model successfully reproduces the endemic

Figure 1 Temporal distribution of herder reports of rinderpest in Somali ethnic areas of East Africa: 1980-1996

18 Participatory Epidemiology: Lessons Learned and Future Directions patterns of disease for both southern Sudan and Participatory Somalia when appropriate sets of parameters are entered to reflect the differences in predominant Epidemiology and rinderpest lineages. Disease Surveillance Model experimentation has been completed to assess the impact of different vaccination This session was introduced with a brief strategies on the probability of disease discussion to establish a consensus on the eradication. Sub-optimal rates of vaccination meaning of the term surveillance and some of the decrease overall mortality but increase the different types of surveillance. The discussion temporal duration of outbreaks. A threshold effect group agreed that surveillance was described by is evident where moderate levels of initial vaccinal the following phrases: population immunity predispose populations to • the collection of information for action, endemic persistence of rinderpest following a disease introduction. • an on-going or continuous process, • information about events The outputs of the model include annual population, • the detection of events prevalence, incidence, mortality and herd immunity • feedback to information to providers and and vaccination. These output parameters can effective response utilized in economic consequence modelling and form the basis for cost-benefit analysis of The group distinguished between general alternative control and eradication strategies. surveillance, where information is collected on a number of disease or health events and targeted This participatory approach to disease modelling surveillance, where information is collected on a demonstrates the power of appropriate specific disease as part of a control strategy. The combinations of qualitative participatory and terms passive and active were also mentioned as quantitative analytical epidemiology. This two categories of surveillance. It was stated that epidemiologic analysis is entirely grounded in an passive surveillance was the routine collection of intimate understanding of the field dynamics of information as part of the normal day-to day rinderpest in the remote and insecure locations activities of the field surveillance. Active were the disease is presently persisting. Such surveillance involves some form of outreach to analysis would not be possible without the direct encourage reporting or actually to collect data in aid of livestock owner’s knowledge to both inform the field. and validate the process.

Figure 2 Rinderpest model structure

Participatory Epidemiology: Lessons Learned and Future Directions 19 After presentations on general and targeted Experiences with assessing and disease surveillance, a discussion was held where participants stressed the importance of quantifying disease surveillance community-based animal health networks as information resources for national disease information for small ruminants as surveillance networks. It was noted that CAHW obtained through the Nomadic networks have been implemented by government, projects and NGOs. The debate Animal Health Auxiliary System centered on how best to incorporate CAHW (NAHA-System) in the Central networks into the surveillance system. Government veterinarians expressed their Rangelands of Somalia frustration at the lack of communication between 1 2 2 veterinary services (VS) and project and NGO- Maximilian P.O.Baumann ,2, Ahmed M. Hassan , Hagi A. Nuux 1Department of International Animal Health, Faculty of Veterinary based animal health programmes. It was noted Medicine, Freie Universität Berlin, Königsweg 67, D-14163 Berlin, that many projects and NGOs had made Germany concerted efforts to involve veterinary services, 2 Formerly: GTZ Veterinary Component, Central Rangeland but in the absence of a policy framework and Development Project (CRDP), Beledweyne, Somalia operating system, it was difficult for CAHW Disease surveillance data were collected during 4 networks to access the national systems. visits to 21 Nomadic Animals Health Auxiliaries (NAHA) from 7 villages/degaans4 (Halgan, Jameeco The following points were made: Muktar, Bulo Burti, Biyo Neef, Aboorey, Maxas, • CAHWs are farmers and have the right to Maqokorey) in Bulo Burti (B/B) district of Hiraan make disease reports. Region from February 1987 to April 1988 using • Monthly monitoring of CAHWs is an important customized data recording sheets. animal health information resource. • A communication gap exists between farmers In an attempt to identify the disease situation as and veterinary services. encountered and reported by the NAHAs and to • VS have no stated policy on the use of CAHW quantify such disease information the following networks as information resources. analytical steps were taken: • VS have not put in place a system to collect First, the common Somali terms used for small animal health information from CAHW ruminant diseases and symptoms in the study networks. district were noted and congruency with scientific • NGOs are usually registered and involve local terminology determined. VS staff in training and monitoring activities at the NGOs expense. Then, the occurrence of a disease/symptom was • Higher levels of the veterinary service are expressed by the number of animals treated/ often not aware of the activities of their field affected (numerator) and the number of flocks veterinarians in CAHW networks as the harbouring animals treated/affected (denominator) veterinary service do not have systems in to calculated the average number of animals place to monitor and coordinate NGO and affected in a flock affected. As flock sizes vary project-based animal health activities. within the district the average flock sizes of 163 in • Effective feedback of summarized information B/B district was used as denominator (and the to data providers (CAHW monitors, CAHWs, factor 100 included) to calculate the percentage and livestock owners) is key to the sustained average animals affected in an average flock. This success of any programme. flock disease index (FDI) served as a measure to quantify a disease as an individual animal problem It was the consensus of the discussion that all or a flock problem, and, thus broken down into the stakeholder were willing and motivated to work following categories, i.e. >0 - 5%, >5 - 10%, >10 - towards integration of community animal health 20%, >20 -30%, >30 - 40%, >40 - 50% and >50%. into the national service delivery and surveillance systems. It was agreed that For the disease data reported differentiation was stakeholder workshops should be held to renew made between the active involvement of the NAHA dialogue on the basis of mutual respect between i.e. inspection and/or treatment of diseased the VS, projects, NGOs, profession and livestock animals, and his role as mediator for disease owners. The objective should be to establish a intelligence evolving from his pastoral community. positive and productive framework for animal health information exchange. 4 The traditionally managed communal grazing area of about 1000 to 3000 km2

20 Participatory Epidemiology: Lessons Learned and Future Directions Reporting periods for each visit were the preceding individual villages/degaan, e.g. being endemic in months whereby the following calender-wise Aboorey and, thus, not causing serious losses. classification for the four different climatic seasons Gu (long rainy season) from March 22 to Sambab, the most prominent disease in B/B June 21, Hagaa (short dry season) from June 22 district, is a dry season disease; over 80% of the to September 21, Dayr (short rainy season) from cases reported and treated by NAHAs occurred in September 22 to December 21, and Jilaal (long the dry seasons Jilaal and Hagaa. The FDI in dry season) from December 22 to March 21, was roughly half of the cases ranged between 5% and applied. Within the district villages/degaans were 10%. However, in a single flock up to 60% of the grouped into ecological sub-zones, i.e. “Inland” animals were found affected. Sambab case fatality (Maxas, Maqokorey, Aboorey and Nooleye) and rates showed a wide range believed to be likely “Riverine” (Bulo Burti, Biyo Neef, Jameeco due to different pneumonia-causing agents and Muktar, Halgan). The age of treated/affected strains. In all cases reported and treated sheep animals was classified according to age groups and goats over 2 years of age were attacked. (0 -1 year, 1.1 - 2 years, over 2 years). Young stock (less or equal to 1 year) played obviously a minor role. The full effectiveness of The case fatality rate of a disease was assessed the antibiotic Oxytetracyclin could be by asking the following question: “If 10 animals demonstrated. are affected by the disease, how many will die without treatment ?” and expressed in percent. A coincidence of anthelmintic treatments asked To enable differential diagnosis and to allow for a for by flock owners with wet and humid climatic more detailed disease description the immune conditions leading to a rise in endoparasites of status (after recovery) of the animals was sheep and goats could be shown. In half of the inquired and recorded as immune (= yes = more flocks 5% to 10% of the animals were considered than 50% of the animals affected) or not-immune to deserve anthelmintic treatment by the NAHAs. (= no = less than 50% of the animals affected). However, a good numer of anthelmintics sold to The effectiveness of the drugs applied did also and administered by the flock owners themselves enter the data collection. reflected the demand for appropriate and effective anthelminthics. The existing confusion for different locally used Somali terms for single diseases, disease In order not to loose potential information syndromes or gross symptoms in sheep and observations regarding diarrhoea, though low in goats, even at the village/degaan level, could be number, were recorded separately. A trend of demonstrated. For instance, the vernacular terms likely occurrence of diarrhoea - a symptom, not a Sambab (literally: lung) and Agmar are considered disease itself - in dry seasons was apparent. to stand for pneumonia, which again was often synonymous for CCPP. For the first time livestock disease surveillance data obtained through veterinary auxiliaries from To deepen the understanding of certain diseases a primary animal health care delivery system in or disease complexes of small ruminants such as Central Somalia, the Nomadic Animal Health Qanje (literally: lymph node), but also termed as Auxiliary System, are demonstrated. Tu or Riimiye in some villages/degaan, oral reports given by the NAHAs on symptoms and post- It has to be considered that the reports of disease mortem findings were listed and broken down by treatments and patterns were provided orally by village/degaan. the local NAHAs and then transferred onto the data recording forms of the CRDP/GTZ Veterinary Flock disease indices for ecological sub-zones Component. Thus, figures generated should not be demonstrated and quantified the importance of taken as absolute, but rather illustrating the Sambab in all villages/degaan of B/B district with magnitude of a condition. Figures are further a marked higher FDI in the “Inland” degaan of confounded by the willingness for veterinary Maxas, where Qanje also seemed to play a attention emerged from the decision of the prominent role. livestock herder that treatment of a diseased animal in his/her flock is economically justified Endoparasites and cases of diarrhoea appeared and, thus, unalterable. Therefore, the methodology with higher “prevalences” in the ecological sub- applied served as a tool to primarily exhibit trends zone characterised as “Inland” than in the in disease patterns and to provide additional data “Riverine” sub-zone. A disease such as FMD in on yet not well defined disease complexes such as small ruminants seemed to be restricted to Qanje in small ruminants.

Participatory Epidemiology: Lessons Learned and Future Directions 21 Disease Surveillance and literate member of the team on a daily vaccination form. These are submitted to the Community-based Animal Health: supervisor who passes them to the NGO for submission to the FAO database. Experience of the Operation Lifeline Sudan Southern Sector In addition, CAHWs report any outbreaks that have been reported to them by livestock keepers, Livestock Programme or any outbreaks observed during their routine work. The CAHWs give an oral report to the Bryony Jones Vétérinaires sans frontières - Belgium, PO Box 13986, Nairobi, supervisor of history and clinical observations. Kenya The supervisor will then follow up by visiting the outbreak and carrying out a basic investigation; history, clinical examination, post mortem examination (if possible) and collect samples (some but not all supervisors have sampling kits and are able to collect and submit samples). The supervisor then fills in an outbreak report form. This is sent to an FAO vet in Lokichokio who is the focal point for outbreak information. The supervisor also reports to the field veterinarian and if he/she is in the area, they will also follow up and verify the findings for the supervisor and collect samples if not already done. If the outbreak is urgent or severe, then outbreak information is sent by radio message. FAO will then follow up the report, either by asking for further information, providing appropriate medicines or vaccines, or by visiting to carry out further investigations.

Treatment, vaccination and outbreak information is collated into a summary report that is reported back to NGOs and field supervisors either quarterly or during livestock co-ordination meetings. Data is used by NGOs and FAO in compiling reports to donors. The OLS Southern Sector Livestock Programme has approximately 1000 CAHWs who have received two Future plans in the context of the final stages of weeks basic training in disease diagnosis, rinderpest eradication: treatment and vaccination. In addition there are - outbreak reporting - to continue with the approximately 150 supervisors who have been existing system but to provide training and trained for 4-9 months in animal health, and field support to improve the quality of approximately 35 field veterinarians employed by investigations, reports and follow up, NGOs/FAO. - active surveillance - CAHWs to be looking for Routine information on cases treated is recorded by rinderpest-like disease and talking with cattle CAHWs on a pictorial monitoring form. owners about possible rinderpest, supervisors Approximately once a month, each CAHW reports to to be carrying out clinical surveillance and his/her supervisor to report on medicine usage, interviewing livestock keepers during routine collection of revenue and treatments carried out. The cattle camp visits, and in markets, supervisors information in the pictorial form is summarized onto also to be involved in sero-surveillance a summary form. This is submitted to the field collecting an agreed number of samples in veterinarian. The NGO extracts any data they require their area for an agreed payment, from the form and then all forms are submitted to - RP Project field staff to carry out participatory FAO for entry into a centralised database. disease searching in areas of possible RP endemicity, or as part of outbreak rumour Vaccination is usually carried out as teams of investigation. CAHWs. Vaccinations carried out are recorded by a

22 Participatory Epidemiology: Lessons Learned and Future Directions Participatory Disease Preparations for PDS Searching • Rinderpest is a disease that depends on the mixing of livestock for survival. Berhanu Admassu and Jeffrey Mariner • There are no known carrier states or examples of Community-based Animal Health and Participatory Epidemiology (CAPE) Unit, Pan African Programme for the Control of Epizootics, chronic infection. Organization for African Unity/Interafrican Bureau for Animal • The virus survives through the continuous Resources, PO Box 30786, 00100 Nairobi, Kenya occurrence of new acute cases in susceptible animals. Introduction • Thus, the virus must continuously find new Participatory Disease Searching (PDS) as part of susceptible animals for survival. participatory epidemiology is enabling • A safe, effective and inexpensive vaccine exists veterinarians to collect information on specific that has been successfully applied in most areas disease situations. This paper describes PDS as where veterinary service delivery is reliable. related to rinderpest. These factors suggest, and indeed experience has The specific methods and processes that are most shown, that remote, marginalized pastoral useful for PDS are: communities, where livestock contact rates are high • Open-ended questions and vaccination is sporadic, are often the reservoir for • Probing the endemic persistence of rinderpest (Mariner, 1996). • Time-lines As a first step, an inventory of remote cultures and • Triangulation (cross-checking of reports and communities should be made and secondary sources data from different sources) of information should be obtained and researched. • Use of key informants • Mapping In PRA, one often looks at ‘proxy indicators’ in • Clinical observation and transects regard to sensitive subjects for which it may be difficult to obtain unbiased direct information. What is the problem? Remoteness, insecurity, and lack of services can serve as proxy indicators for the likely presence of We have to define the problem as precisely as infectious disease when prioritising search areas at possible. For example, in the case of rinderpest the national level. control PDS can be conducted to: It is especially important to avoid ‘tarmac’ or • Ascertain rinderpest status access bias in regard to rinderpest searching. • Establish the last date of a rinderpest outbreak As with any disease investigations, the appraisal • Reveal recent stomatitis-enteritis (S-E) team should carry all necessary sampling materials outbreaks for investigation purposes in case a SE outbreak is encountered. • Collect baseline data for sero-surveillance

PRA checklist for a Participatory Rinderpest Disease Search

1. Introduce the appraisal team as an animal health appraisal. 2. Identify the respondents and establish if they cattle owners. 3. Establish their main herding locations (mapping). Items 1 to 3 introduce the subject and establish the identity of the participants Items 4 to 6 are an expanding enquiry into animal health problems. 4. What are the current cattle disease problems in their herd? If tearing or diarrhoea is mentioned, explore these syndromes in detail. This item investigates what animal health problems the respondents are personally and presently facing. 5. What are the current cattle disease problems in the area? This item inquires into what animal health problems the immediate community is presently facing. 6. Historically, what are the most important disease problems of cattle? This item inquires into the most significant animal health problems the community has faced regardless of time. Invariably rinderpest is mentioned in the response to this question if the cattle owners have experienced outbreaks in the last two decades. Frequently it will be the first disease mentioned. 7. Have they personally seen rinderpest in their lifetimes? What does it look like? 8. When was the last time their cattle where affected by rinderpest? Where did it occur? Where did it come from?

As warranted, further probing questions can be added to cross-check reports made in other interviews, further define cattle movements which may affect the epidemiology of the disease, or to contrast current outbreaks with previous outbreaks in regard to the severity of disease.

Participatory Epidemiology: Lessons Learned and Future Directions 23 Interviewing as a tool for PDS fatal) diseases so make sure that chronic diseases and those which are not fatal, but may lead to One of the objectives of PDS is usually to gather production losses, are also recorded. complete information about all disease situations in the village livestock. Ideally, all owners of the Incidence of disease: it is useful to ask the group relevant livestock species in the village should whether there are diseases that appear only attend the interview. The best people to have at the periodically otherwise one might miss major interview are those that know the animals best. As epidemics that sweep through an area, or conditions with other types of disease searches: that appear only in unusual climatic circumstances. The interviewer should be careful not to communicate their specific interest in rinderpest to Persistent questioning the respondents. If possible avoid travel in vehicles One rule of collecting information through used in rinderpest control activities or with interviews is that you should never be satisfied individuals locally known to be specialized in with the first answer. When a question is asked, rinderpest control. The interview should be there is the danger that the answer could be introduced as a general study of animal health wrong, either for the reasons listed previously, or issues in cattle or a similarly broad theme. else because the experience of the person answering doesn’t represent the experience of the Disease names whole village.

The choice of words is particularly important when It is a good idea, therefore to check and recheck discussing particular disease. The appraisal team every answer that is received. Asking the same will often think about diseases as particular entities, question in several different ways, to several each with a particular separate cause. On the other different people, does this. Each time, the question hand, think more in terms of disease syndromes. focuses on some different aspects of the problem, When an animal behaves in a particular way, and and each answer is compared. If there is some shows particular signs, then it is thought of as a inconsistency, then discussions started to try to particular disease. This disease syndrome may have resolve it and come up with a consensus. a unique local name, or the technical name of a particular disease may be used. The tendency of Topics for probing livestock owners to talk about disease syndromes based on patterns of clinical signs, rather than Probing on specific subjects can provide very useful specific diseases should be kept in mind during the insights into community knowledge on disease interview. Mistakes can be avoided by paying epidemiology, pathology and diagnostic processes. attention to a few points. Often it is best to reserve these probing sessions for especially knowledgeable key informants. These are Don’t use the technical name for a disease when usually more senior members of the community asking about that disease. If you know the local respected and consulted by the community for their name, and understand what disease or diseases it livestock knowledge. truly represents, then use that name. In some situations, the clinical signs and behavior of the Diarrhoeal disease: disease in the population are distinctive enough to In a subset of interviews, the community should be be sure that the name given by owners does refer to probed about the different terms used to describe a single disease. In others, it is not so simple. diarrhoeal disease. Points to be investigated are: The eliciting process of all known cattle disease What terms are used to signify diarrhoea in general? names should be in the language of the community. Are different types of diarrhoea distinguished (i.e. This works particularly well with a small group as bloody vs. non-bloody, acute vs. chronic, etc.) the stories and ideas of one important often spark What specific diseases do they associate with the mind of another. However, there are several diarrhoea? biases that should be avoided. What indicators are used to differentiate between different diarrhoeal diseases? Seasonality: livestock owners are most likely to mention diseases of the current season. After those Disease concepts and methods of rinderpest are elicited, ask specifically for diseases most transmission: prevalent in other seasons and /or year round. It is useful to attempt to understand local concepts regarding the cause of disease and methods of Severity of disease: livestock owners are most transmission. In regard to rinderpest, pastoralists likely to give the names of the most serious (i.e.

24 Participatory Epidemiology: Lessons Learned and Future Directions can often accurately describe risk factors and Analysis of results types of contact that lead to transmission. Knowledge in these areas varies significantly Participatory disease searching is somewhat between communities and it is important not to different from other types of PRA. Most PRA make assumptions. interviews start at a general level and work towards specifics. The interview technique used in PDS Mapping casts an ever-broadening net until the respondents volunteer rinderpest as a problem. At this point the Rinderpest is a disease that depends on cattle interview begins to focus down on EVK regarding contact and movement for its survival. Mapping of rinderpest. This could happen at any of three levels: cattle movement and determination of inter- current personal experience, current personal community contact is a very important activity in observation or in the past. Part of the process of regard to understanding local rinderpest ecology. judging the quality and significance of reports relates to when the respondent introduces the In order to initiate a mapping exercise, respondents subject of rinderpest. should be asked to specify their primary grazing sites by season. Depending on the complexity of the As described previously, reports of rinderpest or bio-climatic system, it may be worth constructing a other SE events should be categorized, tabulated seasonal calendar as a companion exercise. Often, and examined for trends or unifying factors. The pastoralists will specify location names that are not existence of the stomatitis-enteritis outbreak evident on modern maps. These initial questions definition and guidelines for comprehensive often turn to a discussion of just exactly where rinderpest surveillance assists in the analysis of these key resource sites are which naturally leads to rinderpest PDS results. the sketching of maps on the ground.

A broad area about an arm and a half reach should be cleared and smoothed. Usually, participants will naturally gather round and equip themselves with the necessary tools: normally sticks and other objections to assist in drawing and act as land marks. The participants should first be asked to indicate key landmarks such rivers, market towns, major wells or watering sites. Then the grazing sites can be indicated. In addition to normal grazing sites, emergency-grazing areas used in time of drought or insecurity should be indicated. For rinderpest epidemiology, the data on movement, mixing (contact) and trade will be the most significant. These will be key factors in subsequent risk analysis and in disease control strategy design. Movement and contact data relative to the presence of the virus will determine where and when vaccination or surveillance is appropriate.

Clinical observation, sample collection and transects

Before or after an interview, it is always useful to walk the camp, herd and adjacent environment. In rinderpest disease searching, tearing is a sign that can be detected at a distance. If you are walking the herd prior to the interview and note tearing, it is best not to call attention to the sign. Proper clinical exams should be carried out after the interview. The only exception is when the livestock are on the move and you run the risk of losing the opportunity.

Participatory Epidemiology: Lessons Learned and Future Directions 25 Participatory • Economic assessment of CAHWs; • Characteristics of CAHW systems such as effective epidemiology in selection of CAHWs, gender issues and the pros veterinary research and cons of illiterate versus literate CAHWs; • Impact assessment of CAHWs and education

This session involved a discussion group of Training opportunities in veterinary representatives from veterinary schools in the Horn schools of Africa and east Africa region to discuss: • Research needs in participatory epidemiology The group confirmed that very little, if any, training in PE was currently taking place in veterinary • Training needs in participatory epidemiology in schools in the region. Short seminars and veterinary schools introductory training in PE for small numbers of Research needs faculty staff had been conducted at the Faculty of Veterinary Medicine, Sokoine University of Discussion began on conventional versus Agriculture (Tanzania) and the University of Nairobi participatory research approaches, because (Kenya), with support from the CAPE Unit of OAU/ ideally, participatory epidemiology should be used IBAR. within a participatory research context. It was generally agreed by representatives from Conventional and participatory research was Uganda, Ethiopia and Tanzania that more training summarized in the table below. and experience in PE was required in veterinary schools. Various ideas were proposed concerning The point was also made that participatory research whether PE should feature in undergraduate or should be action-orientated and result in products postgraduate courses. Some participants felt that that livestock keepers can use or benefit from. the undergraduate course in their schools was The second part of the discussion focused on already too full to allow space for PE, while others specific areas of research to further refine PE felt that PE was of sufficient importance to methods, apply existing PE methods or further introduce at the undergraduate level. Finally, some examine CAHW programmes. The main research people suggested that PE was still new and that topics were: postgraduate courses were the most appropriate place to teach people about PE. • The use of PE in disease investigation and surveillance; This general interest in greater learning about PE • The use of CAHWs as disease reporters, with indicated that the CAPE Unit should further emphasis on sustainability issues and develop support to veterinary schools in the region. incentives for reporting in a privatized system;

Conventional research Participatory research

Who identifies the research topic? Researcher(s) Users Who plans the research? Researcher(s) Researcher and users Which methods are used? Formal Formal and participatory Who owns the results? Researcher The group had mixed opinions: ‘Should rest with users’ ‘The researcher(s)’ ‘Joint, but depends on funding’ What is the final research product? A scientific paper A technology or adoption of technology Who provides resources? Mainly the researcher, Joint provision of resources via an external funding source Who evaluates the research? The researcher’s manager, The users peers or examiners

26 Participatory Epidemiology: Lessons Learned and Future Directions Session 4 National PACE Programme Working Groups

Tasks for Working Presentations by Groups Working Groups

During this session, participants were divided into 1. Lessons learned during the working groups representing National PACE workshop Programmes from Ethiopia, Kenya, Somalia, Sudan, Tanzania and Uganda. Each working group was PACE Ethiopia requested to complete the tasks described below. • Created more awareness on PE • Methods used and constraints in PE 1. As a working group, what are the main “lessons • Involving local communities in information learned” from the presentations and discussion gathering way of using indigenous knowledge groups during the workshop. List these lessons • CAHWs as collectors of data to be integrated and rank them in order of importance. into national animal health information systems. 2. By reference to the objectives of: • Ways to integrate PE results in conventional • National PACE Programmes research, i.e. • CAPE Unit - Training needs in PE • Veterinary schools and research centres, - Incorporation of PE in research and learning identify specific ways to use participatory institutes epidemiology to add value to PACE. PACE Tanzania Ideas arising from discussion so far include, • Scope and potential application of PE in disease • Use of participatory epidemiology to improve surveillance understanding of epizootic diseases in pastoral • Participatory tools can be used to suit particular areas situations (flexible and adjustable) • Testing of community-based surveillance • Better results/findings can be obtained by the systems use of both quantitative and qualitative • Participatory impact assessment of CAHW methods of investigation services • Results from PE can be used in contemporary • Further development and testing of PE epidemiological techniques, modelling and risk methods and approaches assessment The working group may identify other needs in • Indigenous knowledge can be captured, addition to this list. appreciated and used effectively; cultural and nomenclature differences need to take on board Please be specific. Try to make specific proposals • Appreciation of the involvement and ownership based on your knowledge of existing disease by stakeholders and target groups control priorities and presence of CAHW or other • Often a lack of common understanding about services on the ground. Which diseases should we what PE is, what it can do and best practice and look at in which areas? Who are the key players application who should be involved? What are the deadlines for completing the work? PACE Uganda • PE can help tap the available local knowledge 3. Identify training/educational needs for the various pastoral areas players involved in testing and applying PE in • PE can complement the existing surveillance pastoral areas. systems • PE can generate baseline data that can help to Outline a training plan which specifies who should target surveillance and research be trained (which people in which institutions?) • PE is associated with projects and NGOs - how and when (what are the deadlines by which sustainable are these? training should have taken place?). • PE implies ownership, learning empowerment the local communities

Participatory Epidemiology: Lessons Learned and Future Directions 27 • There is a need to integrate the PE into the 2. Ways to use participatory National Surveillance Network • Need to co-ordinate PE activities at district and epidemiology in National PACE national levels • Need to train personnel in personnel at all Programmes levels in PE methods The common themes in National PACE Programme objectives are: PACE Sudan • Potential for getting information from CAHW 1. Final eradication of rinderpest • How valid - does it fit in the system 2. Strengthening national epidemiology capacity • Comparison between different methodologies PE 3. Control of major epizootics • Exchange of ideas and practices 4. Improved veterinary service delivery and • Respect, recognize and make use of indigenous privatization knowledge to be incorporated into research activities PACE Ethiopia Participatory epidemiology can assist the PACE Kenya programme by: • Use of PE improves the understanding of • Providing information from remote areas epizootic diseases in pastoral areas. • Passive surveillance by making use of CAHWs • Empowers communities to identify and solve through an established system their own problems • Active surveillance using PE methods • PE is not structured questionnaire This will lead to: • Combined qualitative and quantitative is “best • Better understanding of disease practice” • Refining strategies • Useful in testing community-based surveillance • Early warning and early reaction systems • Participatory impact assessment of CAHW Specific activities services • Inventory and assessment of CAHW • Need for further development and testing of PE programmes methods • Establish linkages and improve information flow between CAHW/NGOs and government PACE Somalia veterinary services • To combine PACE Methods with conventional • Introduce PE into CAHW projects (widen scope epidemiology methods to reporting) • PE methods useful for validation of certain • Standardisation of information information, models, concepts • Monitoring and evaluation • PE methods useful for descriptive epidemiology • Collect indigenous knowledge (disease alert, pattern, livestock movement) • Incorporate into teaching and research • Useful for first steps in an area to assess the CAPE can act as an initiator and facilitator of these health situation (if a disease problem exists activities better than disease is mild or endemic) PACE Tanzania In PACE Tanzania, CAHWs are considered under the objective ‘Improvement of the Delivery of Veterinary Services’. So far, PE as a tool was not been included in the implementation/activities in the PACE Tanzania Global Plan. However, PE can be used to add value to PACE. For example, PE has a role in: 1. Strengthening veterinary services - in disease surveillance and delivery of animal health services 2. Privatisation of veterinary service delivery by: - Establishment of links between private vets, other animal health service providers - Fostering the involvement of private vets in epidemio-surveillance 3. Rinderpest eradication - clinical surveillance

28 Participatory Epidemiology: Lessons Learned and Future Directions 4. CBPP control and the control of other epizootics 2. Train ‘trainers of trainers’ in PE. (FMD, ND, RVF, ASF). PE can assist: 3. CAPE facilitates a PE investigation into “Mixed - Surveillance infection syndrome; March 2002. - Control of livestock movements and 4. DVOs and MAAIF conduct continuous improved participation/response in monitoring and evaluation of community-based vaccination campaigns surveillance system in Karamoja region. - Fostering and sensitisation 5. Further development of PE methods in the PACE Overall, PE can enhance livestock owners’ districts. participation and ownership of disease control 6. PE methods will shed light on endemic diseases programmes and syndromes.

CAPE can provide technical and logistical support PACE Sudan in areas involving PE. The Animal Health Services- General roles for PE include: Coordination Programme is responsible for 1. Disease surveillance improved delivery of animal health services. This 2. Disease control includes expansion and proper use of CAHWs 3. Strengthening veterinary services under the supervision of vets in pastoral areas. 4. Disease diagnosis 5. Research - centers include: Specific proposals for immediate application of PE - 11 regional vet labs in the regions 1. Rinderpest surveillance - support to clinical - 3 vet schools surveillance (Dec. 2001- July 2002) - veterinary training center (KRT). 2. African swine fever - involving livestock Use of PE through CAHWs, local leaders and keepers, raising awareness and improving livestock owners. Activity already practiced in N. surveillance and control Kordofan and Darfur on-going. In the southern 3. CBPP - surveillance; impact assessment of CBPP sector through FAO, PE is used in the South to find (vaccination versus control) RP outbreaks in infected zones to complement 4. Newcastle disease - socio-economic studies PACE programmes. PE also used during vaccination teams. Various activities include research centres such as the Animal Diseases Research Institute (ADRI) and PACE Kenya veterinary investigations centers. Roles for PE can be categorized according to three main programmes or players: Also need to consider veterinary training institutes - CAPE to support curriculum development to A. In the PACE Kenya Programme include PE in undergraduate and postgraduate 1. Envisage PE to improve epidemio-surveillance training: network through disease surveillance and • Short course - for epidemiologist/field officers reporting. Specfically, (by December 2002) - Rinderpest eradication process • Training of trainers (by April 2002) - Improve the control of other epizootics: CBPP, FMD, RVF, LSD Key Players: - Strengthen private - public sector linkages in - Livestock keepers - associations, groups delivery of animal health services - Livestock field officers 2. Will help in the understanding the socio- - Livestock traders economics of major epizootics and therefore - Private veterinarians shape/refine their control strategies -DVDS Our priority areas are the pastoral areas (Zone II - VICs and ADRI & III) and the key players are public vets, NGOs - DVS (Epidemiology Unit) and CAHWs, and private vets. Timeframe - - University/SUA duration of PACE and beyond.

PACE Uganda B. In the CAPE Unit 1. Integrate and co-ordinate PE with other 1. Streamlining the delivery of vet services in surveillance and other epidemiological pastoral areas tools for RDP, CBPP, CCPP, OOR, FMD, ASF, LSD, 2. Streamlining data collection in pastoral areas RVF, rabies and other diseases. Players include 3. Linkages within the region MAAIF, National Agricultural Research Organizations, Faculty of Veterinary Medicine and C. Veterinary Schools and Research Institutes private veterinary practices; timeframe - 6 months. 1. Introduce PE in training curriculum

Participatory Epidemiology: Lessons Learned and Future Directions 29 2. Utilize PE in research on animal diseases and Who to train? program evaluation. Already underway are the Veterinarians, CAHWs and policy makers should all following research projects involving PE: receive training. CAPE should provide training • Trypanosomiasis in camels materials and Training of trainers courses. •CBPP • Business planning in Animal Health Services PACE Sudan training needs Delivery in pastoral areas PACE Sudan suggested that initially, a general 3. Training needs awareness-raising workshop was required for supervisors and policy makers. Specific PE training PACE Ethiopia training needs events could then follow, particularly to train Trainees for PE training should be selected from: veterinarians in PE ad apply it in communication, - PACE monitoring and evaluation, and data collection and - Veterinary field services analysis. - Research Institutes - Teaching Institutes CAPE should provide support in the form of - NGOs involved in CAHW programmes training trainers, and resources to assist further training courses in Sudan.

PACE Uganda training needs

Players Training Needs Time Scale CAPE support

MAAIF, Policymakers, Awareness in PE June 2002 Logistics PACE staff, TOTs/ advanced March 2002 Trainers Epidemology staff

LG, District staff, Basic PE Continuous Extension workers

Researchers TOT/Advanced PE March 2002 “

Private sector, PVPs, Basic TOT Continuous “ NGOs

CAHWs Basic Continuous “

Pastoralists Awareness Continuous “

PACE Kenya training needs

Players Type of training When?

University lecturers TOT - PE In place

University students (undergraduates)PE ?

Vets in pastoral areas TOT - PE 2002 Epidemiologists Key NGO staff

Other public, NGO, Private, PE 2002 and beyond CAHWs extension personnel + VIL teams

30 Participatory Epidemiology: Lessons Learned and Future Directions PACE Tanzania training needs

Players Training Needs Time Scale CAPE support

Training institutes/ Training of trainers - April 2002 Financial resources veterinary schools in new developments for establishment of of PE; in-depth short course programme Curriculum development

Research institutes/ Basic training in PE April 2002 Financial other Zonal- disease (short course) resources investigation centers Advanced training in PE e.g. Trainers Research methodologies

National Epidemiology Basic and advanced April 2002 Financial other Unit/Epidemiologists training in PE resources e.g. Trainers VICs - zonal vet. Basic training in PE Dec. 2002 Financial Research officers Training material

DVOs Basic training in PE April 2003 “ Private vets and Basic training and July 2003 “ Livestock Field practice of PE Officers (LFOs) in the field

CAHWs On-the- job training Continuous “

Livestock farmers Awareness raising Continuous “ on-farm Policy makers Awareness raising July 2002 “

It was suggested that general awareness training PACE Somalia training needs was also required to familiarise policy makers and In PACE Somalia, PE training needs included staff farmers. in the Somalia Livestock Professional Forum (SLPF), National Coordination Unit, Zonal The role of the CAPE Unit in training was provision Coordination Units (4) and Zonal Professional of expertise, technical back-stopping and funding. Associations. Private veterinarians under contract to PACE Somalia should also be trained.

Participatory Epidemiology: Lessons Learned and Future Directions 31 Annex 1 Workshop timetable

Day 1 Thursday 15th November

8.30 - 9.00am Registration of participants 9.00 - 9.30am Welcome Background and objectives of the workshop 9.30 - 10.00am Opening speech by Ato Belay Ejigu Vice Minister, Ministry of Agriculture 10.00 - 10.30am Coffee break 10.30 - 11.30am Presentation “Participatory Epidemiology: Setting the Scene” 11.30 - 12.30am Presentation “Livestock keeping and indigenous knowledge in the Horn of Africa: Personal reflections on 25 years experience” 12.30 - 2.00pm Lunch 2.00 - 3.00pm Issues affecting the wider use of participatory epidemiology Issue 1. Qualitative verses quantitative methods 3.00 - 3.30pm Tea break 3.30 - 4.30pm Issues affecting the wider use of participatory epidemiology Issue 2. Methodological issues 4.30 - 4.45pm Summary of Day 1

Day 2 Friday 16th November 9.00 - 11.00am Working Groups by country 9.00 - 10.00am Issues affecting the wider use of participatory epidemiology Issue 3. Training and practice Session “The Ideal Qualities of a Participatory Epidemiologist” 10.00 - 10.30am Coffee break 10.30 - 11.00am Where can Participatory Epidemiology fit into PACE? - Introduction 11.00 - 12.30am Improving epizootic disease control using combined participatory and modelling approaches 12.30 - 2.00pm Lunch Group 1 Group 2 Mainly of interest to PACE Mainly of interest to researchers epidemiologists involved and academics in epizootic disease control 2.00 - 3.00pm Participatory epidemiology Use of participatory approaches and disease surveillance and methods in community-based animal health services 3.00 - 3.15pm Tea break Tea break 3.15 - 3.45pm Participatory epidemiology and Participatory epidemiology and disease surveillance (continued) research: Experiences and opportunities 3.45 - 4.45pm Participatory Disease Searching Participatory epidemiology and veterinary education 4.45 - 5.00pm Summary of Day 2

32 Participatory Epidemiology: Lessons Learned and Future Directions Day 3 Saturday 17th November

9.00 - 11.00am Working Groups by country - Identify opportunities for using PE to complement national PACE Programmes - Describe specific activities in terms of disease problems to be addressed, priority geographical areas and key players to be involved in each activity - Identify training needs related to the above. Who should be trained, how should they be trained? - Outline a work plan for incorporating PE-related activities into each national PACE programme. 11.00 - 11.30am Coffee break 11.30 - 12.00am Group presentations - PACE Ethiopia 12.00 - 12.30am Group presentations - PACE Somalia 12.30 - 2.00pm Lunch 2.00 - 2.30pm Group presentations - PACE Tanzania 2.30 - 3.00pm Group presentations - PACE Kenya 3.00 - 3.15pm Tea break 3.15 - 3.45pm Group presentations - PACE Uganda 3.45 - 4.15pm Group presentations - Sudan 4.15 - 5.00pm Outstanding issues, Workshop evaluation and close

Participatory Epidemiology: Lessons Learned and Future Directions 33 Annex 2 Tambi Emmanuel OAU-IBAR-PACE List of participants Economic Unit Nairobi Kenya

Mekonnen Hailemariam Ahmed Hussein Abdel Rahman Faculty of Veterinary Medicine Veterinary Research Corporation Addis Ababa University Sudan Addis Ababa Ethiopia Ali Mohamed Gedi Somali Livestock Professionals Forum Solomon Nega Somalia Ministry of Agriculture Addis Ababa William Amanfu Ethiopia FAO Rome Italy B.M. Mugenyo Veterinary Services Department Kenya Kaleb Bassa Kenya PACE Communication Ministry of Agriculture Abdullatif Mohamud Abdi Addis Ababa Somali Livestock Professional Forum Ethiopia Somalia

Beshahwred Shiferaw Stefano Tempia PACE Harar Coordinator PACE Somalia Ethiopia Nairobi, Kenya

Bryony Jones Tesfaye Alemu VSF Belgium Oromia Regional Agricultural Bureau Sudan Ethiopia

G.W. Nasinyama Bitew Getinet Faculty of Veterinary Medicine Amhara Region Agricultural Bureau Makerere University Ethiopia Uganda

Bekele Batiso Dessalegn Sida Bedele PACE Coordinator Addis Ababa PACE coordinator Bedele Ethiopia Ethiopia

Osman Sorkatti A.K. Karugah PACE Headquarters Veterinary Service Department Kenya Sudan Kenya

Tariku Sintaro Solomon Mekuria PACE Ethiopia Awassa PACE Coordinator Ethiopia Awassa Ethiopia Yirgalem G/meske EARO (NAHRC- Sebeta) Gijs Van’t Klooster Ethiopia FAO Ethiopia Gavin Thomson OAU/IBAR Darlington Akabwai PACE Programme CAPE Unit Kenya Kenya

34 Participatory Epidemiology: Lessons Learned and Future Directions B.E Lema Sileshi Zewdie Animal Disease Research Institute, PACE - Coordinator Ministry of Water and Livestock Development Ministry of Agriculture Tanzania Ethiopia

Hanan Yousif M.A Professor M.M. Kagiko PACE Epidemology Unit University of Nairobi Sudan Faculty of Veterinary Medicine Kenya Solomon Tibebu PACE Ethiopia Enquebaher Kassaye National Coordinator Office Mekelle Regional Veterinary Laboratory Ethiopia Ethiopia

Dr. Mohammed M. Bahari Maximilian Baumaun National PACE Programme Coordination Freie University of Berlin Ministry of Water and Livestock Development Germany Department of Veterinary Services Tanzania Tony Wilsmore VEERU Habiba S.H. Hamid University of Reading OAU/IBAR/PACE/CAPE Unit UK Somalia Dickens Malangh Chibeu Dawit Abebe PACE Epidemiology Unit FAO Kenya Addis Ababa Ethiopia Mukiibi Muka LIRI Francis F. Sudi Uganda Ministry of Water and Livestock Development PACE Program Sharadhuli I. Kimera Department of Veterinary Services Sokoine University Tanzania Faculty of Veterinary Medicine Tanzania Daynachew Sahele PACE Ethiopia Gebretsadik Berhe Bahr Dar Coordination Office PACE Ethiopia Ethiopia Mekele Branch Coordinator Ethiopia Yohannes Afework Ministry of Agriculture Kebede W/Giorgis Ethiopia Tigray Region Ministry of Agriculture Girma Abeto Ethiopia PACE Ethiopia Kombolcha Branch Kisa Juma Ngeiyna Ethiopia Veterinary Department Kenya Yilkal Asfaw Faculty of Veterinary Medime, F.K. Wandaka Addis Ababa University Department of Veterinary Services Ethiopia Ministry of Agriculture & Rural Development Kenya Michael Thrusfield University of Edinburgh UK

Participatory Epidemiology: Lessons Learned and Future Directions 35 John McDermott Dessalegn Sida International Livestock Research Institute PACE - Ethiopia Nairobi Addis Ababa Branch Coordinator Kenya Ethiopia

Gerard Laval Bitew Getinet International Livestock Research Institute Amhara Region Addis Ababa Ethiopia Ethiopia Yohannes Afework Kassaye Hadgu Ministry of Agriculture FAO Ethiopia Addis Ababa Yilkal Asfaw Ethiopia Faculty of Veterinary Medicine Ethiopia Chris Rutebarika PACE Uganda Bekele Batiso Uganda PACE-Ethiopia Bedele Branch Coordinator Noelima Nantima Ethiopia PACE Epidemiology Uganda Beshahwred Shiferaw PACE - Ethiopia Berhanu Bedane Harar Branch Coordinator PACE - OAU/IBAR Ethiopia Nairobi Kenya Kebede W/Giorgis Tigray Region Kisa Juma Ngeiywa Ministry of Agriculture Kenya Veterinary Department Ethiopia Kabete Kenya Enquebaher Kassaye Mekelle Regional Veteinary Laboratory Sileshi Zewdie Northern Ethiopia PACE - Ethiopia Coordinator Ethiopia Ethiopia Salome Kairu Wanyorke Ali Adam Tahir Veterinary Department Extension Training and Pastoral Development Ministry of Agriculture Sudan Kenya

Gezu Bekele Hanan Yousif M.A FARM-Africa ADDP PACE - Sudan Ethiopia Sudan

Yirgalem G/Meskel Lulseged Belay National Animal Health Research Center (EARO) BOA, Veterinarian Sebeta Afar Ethiopia Ethiopia

Girma Abeto Solomon Tibebu PACE - Ethiopia PACE - Ethiopia Kombolcha Branch Coordinator Emergency Unit Ethiopia Ministry of Agriculture Ethiopia

36 Participatory Epidemiology: Lessons Learned and Future Directions Tesfaye Alemu Annex 3 Oromia Agricultural Bureau Ethiopia Participants’ evaluation

Yazew Dego of the workshop PACE - Ethiopia Dodola Branch Coordinator Participants were asked to score from 1 (very poor) Ethiopia to 5 (excellent) the following criteria for evaluating the workshop: Legesse Teklegiorgis - relevance of objectives PACE - Ethiopia - achievement of objectives Bahir Dar Branch Coordinator - relevance and value of presentations Ethiopia - relevance and value of group discussions and presentations Solomon Mekuria - quality and relevance of handouts Awassa PACE - time allocated to presentations Ethiopia - time allocated for questions and discussion - general organisation and logistics and for Berhanua Admasu the workshop CAPE Unit - accommodation PACE Programme, OAU/IBAR Addis Ababa Results from 52 respondents are summarized Ethiopia below.

Jeffrey C. Mariner Consultant CAPE Unit, PACE Programme, OAU/IBAR, PO Box 30786 Nairobi, Kenya

Andy Catley CAPE Unit PACE Programme, OAU/IBAR PO Box 30786 Nairobi Kenya

Participatory Epidemiology: Lessons Learned and Future Directions 37 COMMUNITY-BASED ANIMAL HEALTH & PARTICIPATORY EPIDEMIOLOGY UNIT (CAPE) PO Box 30786 Nairobi, Kenya Tel: (254-2) 226447/334550/240591 Fax: (254-2) 253680/226565

PAN AFRICAN PROGRAMME FOR THE CONTROL OF EPIZOOTICS ORGANIZATION OF AFRICAN UNITY (OAU) INTER- AFRICAN BUREAU FOR ANIMAL RESOURCES (IBAR)